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        תוצאת חיפוש

        יוני 1997
        ר' מושיוב, ד' סגל ומ' ליברגל

        Immediate Orthopedic Surgery in Multiple Trauma


        R. Mosheiff, D. Segal, M. Liebergall


        Orthopedic Dept., Hadassah Medical Center, Jerusalem


        The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.

        שלמה וינקר, ששון נקר, סרגיי פינקל, עמנואל ניר ואיתן חי-עם

        Oral Anticoagulation Therapy in the Primary Care Setting


        Shlomo Vinker, Sasson Nakar, Sergei Finkel, Emanuel Nir, Eitan Hyam


        Family Medicine Dept., Sackler Faculty of Medicine, Tel Aviv University; and Shaaraim Clinic, General Sick Fund, Rehovot; Central Cinical Laboratories, and District Medical Director, Central District of the General Sick Fund


        The use of oral anticoagulant therapy (OAT) to prevent thromboembolism has been widespread in recent years. The concept of high- and low-intensity regimens has facilitated treatment for many, and has lowered the hazards of overly intense anticoagulation. However, a significant proportion of patients suited to the low intensity regimen are not being treated. It is not clear whether its wider use is limited by continued debate, lack of resources, lack of expertise, or other causes. We retrospectively reviewed the medical records of 32 patients treated with OAT administered in the primary care setting. The average age was 66±11 years (range 34-84). 9 were treated with high-intensity OAT: 8 due to artificial heart valves, and 1 due to a hypercoagulable syndrome with recurrent thromboembolism. 23 were treated with low-intensity OAT, 17 of whom had atrial fibrillation. 11 were also being treated continuously with other medication which interacted with OAT or interfered with other coagulation pathways. Such medication included: aspirin, dipyridamole, amiodarone, bezafibrate and allopurinol. Of 414 coagulation tests, 57% and 65% were in the therapeutic range in the high- and low-intensity OAT groups, respectively. There was no major bleeding event, but in 2 of 8 who bled, gastrointestinal bleeding led to hospitalization. Treatment was discontinued in 1 patient because of difficulties in achieving target INR, and in the 2 hospitalized for bleeding. The percentages of test results in, above and below the therapeutic range were similar to those in other large series, for both intensity regimens. We found that a significant proportion of patients were under chronic treatment with other medication which interacted with OAT. To estimate the rate of complications in primary care OAT, larger series are needed. We conclude that OAT can be given and monitored by the family physician, and that awareness of long and short term drug interactions with OAT is mandatory.

        אמיר ויזרי, אלי מימון, משה מזור, אילנה שוהם-ורדי, טלי זילברשטיין, ארנון ויז'ניצר ומרים כץ

        Effect of the Yom Kippur Fast on Parturition


        A. Wiser, E. Maymon, M. Mazor, I. Shoham-Vardi, T. Silberstein, A. Wiznitzer, M. Katz


        Depts. of Obstetrics and Gynecology and of Epidemiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba


        Food-withdrawal has been proposed as a possible mechanism for initiating the onset of labor in animals and humans. The hypothesis was based upon the reported increase in deliveries of infants during the Yom Kippur fast. We studied the effect of the fast on full term deliveries of Jewish women, with non-fasting Bedouin women as controls (1988-1995, 1,313 Jewish and 1,091 Bedouin deliveries). To determine the effect of Yom Kippur itself, delivery rates on Sukkot and Yom Kippur were compared in both groups. The mean delivery rate in the Jewish population was significantly higher during Yom Kippur and the day after, than during the 7 days before Yom Kippur (15.1±5.1 and 14.6±4.7 vs 10.7±3.5, p<0.04 and p<0.01, respectively). There was an increase in delivery rate during the 6 hours before the end of the fast. In the Bedouin women there were no changes in delivery rate during any of these periods. There were no significant differences in the rates of deliveries during the Sukkot festival between Jewish and Bedouin women. We conclude that fasting is associated with a significant increase in the rate of deliveries at term.

        מאי 1997
        רון בן-אברהם, מיכאל שטיין, יורם קלוגר, אמיר בלומנפלד, אברהם ריבקינד ויהושע שמר

        ATLS Course in Emergency Medicine for Physicians?


        Ron Ben-Abraham, Michael Stein, Yoram Kluger, Amir Blumenfeld, Avraham Rivkind, Joshua Shemer


        Medical Corps, Israel Defense Forces; and Trauma Units of Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, and of Hadassah Hospital, Jerusalem


        Implementation of Advanced Trauma Life Support (ATLS) skills among practicing physicians and its perceived utility in their civilian practices, as well as in their potential army combat assignments, was evaluated. 177 physicians in various subspecialties, who were graduates of ATLS training courses, answered a specially designed telephone questionnaire. An unexpectedly high percentage of physicians (47%) had used their ATLS training when called to treat trauma victims. 67% of physicians stressed the contribution of the ATLS course to enhancing their skills. We believe that a properly designed ATLS course for general practitioners would be very beneficial for trauma victims.

        איתן מור, דן שמואלי, זיו בן-ארי, נתן בר-נתן, עזרא שהרבני, אלכסנדר יוסים, בוריס דורפמן, רן טור-כספא וזכי שפירא

        Liver Allografts from Donors older than 60: Benefits and Risks


        Eytan Mor, Dan Shmueli, Ziv Ben-Ari, Nathan Bar-Nathan, Ezra Sharabani, Alexander Yussim, Boris Dorfman, Ran Tur-Kaspa, Zaki Shapira


        Transplantation Dept. and Institute of Liver Diseases, Rabin Medical Center, Beilinson Campus; and Sackler School of Medicine, Tel Aviv University


        With limited organ resources and an increasing number of candidates for liver transplantation, the world-wide trend is towards using liver allografts from donors older than 60 years. This strategy, however, may be hazardous because of the known correlation between advanced donor age and graft dysfunction. Since January 1996, each of 5 patients received a liver allograft from a donor older than 60 years. Preservation time in these cases was shortened as much as possible and liver allografts were used only if there were no other potential risk factors for primary nonfunction. Mean cold ischemic time was significantly shorter in this donor group (7.8 hrs) than for livers from 28 younger donors (10.2 hour; p<0.01). 3 of the 5 grafts from older donors had normal function immediately. The other 2 initially had biochemical features of preservation injury, but graft function returned to normal within the first week after transplantation. All 5 patients currently have normal graft function, with follow-up ranging from 3-8 months. There was no difference between the 5 recipients of grafts from older donors and 28 adult recipients of grafts from younger donors in extent of preservation injury and in immediate graft function. We conclude that in countries with limited organ resources, such as Israel, liver allografts from older donors can be used within defined limits and minimal preservation time.

        מרדכי קליגמן, בני ברנפלד ומשה רופמן

        Recurrent Chronic Multifocal Bone Infection


        Mordechai Kligman, Benny Bernfeld, Moshe Roffman


        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa


        We present a 9-year-old girl who had chronic recurrent multifocal osteomyelitis. The bones involved were: right clavicle, distal fibula (bilateral), left sacroiliac and right wrist. After 10 years of follow-up, she is asymptomatic but presents radiological evidence of lesions in the right clavicle and left sacroiliac joint. The diagnosis was made by exclusion criteria. The biopsy and results of cultures from various bones were negative 4 times. Although chronic recurrent multifocal osteomyelitis is rare, it should be considered in the differential diagnosis of acute or chronic osteomyelitis and neoplasms. Its recognition avoids unnecessary laboratory tests and antibiotic therapy.

        א' שחר, ר' שרון, מ' לורבר וש' פולק

        Angioedema Caused by Splenectomy with Malignant Lymphoma Foll-Owed by Multiple Myeloma 7 Years Later


        A. Shahar, R. Sharon, M. Lorber, S. Pollack


        Institute of Allergy, Clinical Immunology and AIDS and Institute of Hematology, Rambam Medical Center and B. Rappaport Technion- Faculty of Medicine, Haifa


        Acquired C1-inhibitor (C1-INH) deficiency has been reported in patients with immunoglobulin abnormalities and lymphoproliferative disorders, and angioedema has appeared simultaneously with the lymphoproliferative disease. We present a 50-year-old woman with acquired C1-INH deficiency and angioedema which preceded by 7 years the diagnosis of malignant mantle cell lymphoma. During the interval she was treated with Danazole and there were no attacks of angioedema. When routine follow-up bone marrow aspiration revealed infiltration of nonspecified lymphoma cells, exploratory laparotomy and splenectomy were performed. A month later Danazol was stopped, C1-INH levels returned to normal and there were no attacks of angioedema. Mantle cell lymphoma consisting of lymphocytes with cytoplasmic IgM-lambda was diagnosed in the excised spleen but chemotherapy was not initiated. 6 months later, a second lymphoproliferative disorder, multiple myeloma IgA kappa, was diagnosed.

        ר' דורסט ופ' רבאודנגו-רושקה

        Attention Deficit Hyperactivity Disorder, Facilitating Alcohol and Drug Abuse in an Adult


        R. Durst, P. Rebaudengo-Rosca


        Talbieh Mental Health Center, Jerusalem (Affiliated with the Hebrew University-Hadassah Medical School)


        Attention-deficit hyperactivity disorder (ADHD) has been considered a mental and behavioral disorder of childhood and adolescence. It is being increasingly recognized in adults, who may have psychiatric co-morbidity with secondary depression, or a tendency to drug and alcohol abuse. We describe a 32-year-old woman known for years as suffering from borderline personality disorder and drug dependence (including hasshish, marijuana, LSD and "exstasy'") and alcohol abuse that did not respond to treatment. Only when correctly diagnosed as ADHD and appropriately treated with the psychotropic stimulant, methylphenidate (Ritalin), was there significant improvement. She succeeded academically, which had not been possible previously, the craving for drugs diminished and a drug-free state was reached. Although administration of psychostimulants to drug abusers is controversial, as they are addictive, in cases of ADHD they have promoted drug abstinence.

        דוד ב' ויס, שושנה גוטשלק-סבג, אלחנן בר-און, צבי צוקרמן, יגאל גת ובנימין ברטוב

        Seminiferous Tubule Cytological Pattern in Infertile, Azoospermic Men in Diagnosis and Therapy


        David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman, Yigal Gat, Benjamin Bartoov


        Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva and Male Infertility Laboratory, Dept. of Life Sciences, Bar-Illan University, Ramat Gan


        We determined spermatogenic patterns of seminiferous tubules in azoospermic infertile men and evaluated the prevalence of bilateral testicular homogeneity. 185 azoospermic men underwent bilateral testicular fine-needle aspiration (TFNA) in which each testis was punctured at 3 different positions. Aspirated material was stained and classified according to the most mature spermatogenic cell type present or whether only Sertoli cells were present. 35.7% had spermatozoa in their testes, 36.2% had spermatogenic maturation arrest, and 28.1% had only Sertoli cells in their seminiferous tubules. In 15.6% of all patients, the diagnosis in 1 testis differed from that in the other. In only 73.2% of those with testicular spermatozoa was it bilateral. In the remaining 26.9%, only Sertoli cells, spermatocytes or spermatids were found as the most mature cell type in the other testis. The study definitely indicates that fertilization with retrieved testicular spermatozoa should not be offered to azoospermic patients without prior evaluation of the seminiferous tubue spermatogenic pattern in both testes.

        ולאדימיר קורן, רוברט קולדנוב, עדנה פלג, אווה איזאק, מאיר ברזין ותלמה רוזנטל

        Red Cell Na+/H+ Exchange and Role of Protein Kinase C in its Stimu-Lation in Diabetes Mellitus, Essential Hypertension and Nephropathy


        Wladimir Koren, Robert Koldanov, Edna Peleg, Eva Izsak, Meir Berezin, Talma Rosenthal


        Dept. of Medicine C, Hypertension Unit and Endocrinology Institute, Chaim Sheba Medical Center, Tel Hashomer


        Na+/H+ exchange (NHE) was measured as maximal initial velocity of pH-dependent H+ efflux from red cells into an alkaline medium containing Na+ in patients with insulin-dependent or noninsulin-dependent diabetes, with and without hypertension and in normoglycemic, essential hypertensives and normal controls (50 subjects in each subgroup). Maximal velocities of NHE were found in microalbuminuric patients in all subgroups, and NHE correlated with the rate of microalbuminuria (r=0.61, p=0.02). Daily insulin requirements were greater in those with elevated NHE (84±8 vs 42±4 U/day). There was no correlation between NHE and levels of plasma glucose, HbA1 and plasma aldosterone and lipid profile and PRA. NHE was correlated with plasma prolactin (r=0.51, p=0.02) and PTH r=0.24, p=0.05). In uremic patients, NHE was inversively correlated with creatinine clearance (r=-0.48, p=0.03). Since calphostin C, a selective inhibitor of protein kinase C, lowered increased NHE in vitro, the protein kinase C-dependent pathway of the exchanger regulation was concluded to be responsible for NHE activation in diabetes mellitus and essential hypertension.

        אפריל 1997
        סרג'יו מרצ'בסקי ושושנה וייס

        Characteristics of Hospitalized Alcoholics


        Sergio Marchevsky, Shoshana Weiss


        Residential Center for Alcoholics and Israel Society for the Prevention of Alcoholism, Ramat Gan


        The background characteristics of 1,173 alcoholics hospitalized for 3 months in this center during December 1982 to December 1994 were reviewed. Socio-demographic variables and termination-of-treatment data, are described. The profile of the typical hospitalized alcoholic was that of a Jewish, urban, married, unemployed man, born in Asia-Africa (or in Israel) who had been living for many years in Israel and had many children and a low educational level. They usually start drinking in adolescence and come to the center after more than 15 years of drinking, mainly at home and alone, and also have family relatives who drink. Implications of the data for treatment and for family physicians are presented.

        מוני בניפלא, דרורה פרייזר, צבי ויצמן, עמליה לוי ורון דגן

        Epidemiologic Characteristics of Pediatric Emergency Room Referral and Hospitalization for Diarrhea in the Negev


        Moni Benifla, Drora Fraser, Zvi Weizman, Amalia Levy, Ron Dagan


        Dept. of Epidemiology and Health Services Evaluation and S. Daniel International Center for Health and Nutrition, Ben-Gurion University of the Negev, and Pediatric Dept. and Pediatric Infectious Disease Unit, Soroka Medical Center and Ben-Gurion University of the Negev


        Diarrheal diseases weigh heavily on the health of children, especially in developing countries, but also impose burdens on health care services worldwide. This study was performed to determine whether patterns of referrals in the Negev to the pediatric emergency room (PER) for diarrhea differ between the Jewish and Bedouin populations of the Negev, and the extent of the burden imposed on the PER and in-hospital services in the Negev. Characteristics of referrals and hospitalizations were examined from March 1994 to February 1995. Of the 27,834 referrals to the PER for children under 16, 2518 (9%) had diarrhea and there were 5,169 hospital admissions, 701 (13.6%). The annual rates of referral were 146 per 10,000 in Jews and 225 in Bedouin, giving an odds ratio (OR) of 1.5 (p<0.001). for Bedouin. The rates of hospitalization were 23 per 10,000 in Jews and 99 in Bedouin (OR 4.4, p<0.001). 1380 (54.8%) of the PER referrals were of infants under a year of age. For hospitalization, the annual rates were 164 per 10,000 in Jews and 756 in Bedouins (OR 4.9, p<0.001). During June to August referrals and hospitalizations for diarrhea were significantly higher, and from December to February significantly lower than during the remaining months. These differences arise from the marked seasonal pattern in the Bedouin population, whereas in the Jewish population there was no seasonal variation. Even in the 90's the burden on health services in the Negev as a result of diarrheal illness is considerable and the Bedouin population still contributes to that burden disproportionately. There is need both to reduce the gap in referrals and hospitalization between the populations, as well as to reduce the rates, using currently available means such as education, while developing new technologies, such as vaccines.

        משה סלעי, אלינור גושן, תומס טישלר, רוני וויצן, שרה אפטר, אלכס גרניאק ומרינה פרלמן

        Multidisciplinary Approach to the Treatment of Musculo-Skeletal Tumors


        M. Salai, E. Goshen, T. Tishler, R. Weitzen, S. Apter, A. Garniek, M. Feldman


        Depts. of Orthopedic Surgery, Nuclear Medicine, Oncology, Imaging Radiology and Pathology, Chaim Sheba Medical Center, Tel Hashomer


        Tumors of the musculoskeletal system are relatively rare. They occur mostly in the young, while in older age groups metastases and myeloma are more prevalent. Treatment has undergone major change in the past 20 years with the introduction of neoadjuvant treatment protocols. According to recent reports 5-year survival rates have increased from 20% to 60-70%. These new protocols involve the use of modern imaging modalities, immunohistochemical pathological analysis and improved surgical technics. This has required establishment of multidisciplinary teams of experts to escort the patient through all the steps of current treatment.

        יצחק אשכנזי ויהושע שמר

        Smoking Habits of Young Israeli Soldiers


        I. Askenazi, J. Shemer


        Medical Corps, Israel Defense Forces, and Sackler Faculty of Medicine, Tel Aviv University


        A random sample of 32,166 soldiers were interviewed (on their day of discharge from the Israeli Defence Forces, between 1980-1995) with regard to smoking habits. Among men, prevalence of current smoking was 46.8%, and among women 32.9%. Over the study period, prevalence in men decreased 27%. Among women, prevalence decreased from 1981 to 1991, but since then it has steadily increased. Among men, mean number of cigarettes smoked decreased from 21.6 in 1989 to 16.6 in 1995. Among women cigarettes smoked decreased from a mean of 14.3 in 1989 to 13.1 in 1995. 65.9% of the men and 49.3% of the women had started smoking by the age of 18. Among men the age distribution of smoking changed hardly at all over the years of the study. However, the proportion of women who began to smoke in the youngest age bracket (15 years of younger) doubled over the course of the study.

        דורה סגל-דופרשמיט, אורנה דלי-גוטפריד ואנטוני לודר

        Water Intoxication following Desmopressin Overdose


        D. Segal-Kuperschmit, O. Dali-Gotfrid, A. Luder


        Pediatric Dept., Rebecca Sieff Hospital, Safed


        Water intoxication is a serious condition which may be caused by desmopressin overdose, with reversible or irreversible neurological complications. In the past, desmopressin was used in endocrinological centers for the treatment of anti-diuretic hormone deficiency (central diabetes insipidus). Indications for hormone treatment have since widened, especially as an effective solution for nocturnal enuresis. It is now often prescribed in community clinics, and its use has been encouraged by extensive promotion. We describe a 15-year-old boy with primary nocturnal enuresis who started treatment with desmopressin 1 year prior to admission. He was allowed to use the drug without supervision, and drank excessively. The result was water intoxication which required admission for intensive care because of loss of consciousness and convulsions for 36 hours.

        הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303